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MBA Trust - Glossary
The following is a list of definitions commonly used regarding your health care coverage and contains definitions of terminology specific to the MBA Health Insurance Trust.
Allowed Amount - The amount commonly charged for a particular medical service by physicians within a particular geographic region. Previously known as UCR (Usual, Customary and Reasonable fee), allowed amounts are used by traditional health insurance companies as the basis for physician reimbursements.
Asuris Northwest Health - Based in Eastern Washington, Asuris Northwest Health offers an extensive health care provider network and responsive local services to that region of our state. Asuris is dedicated to providing affordable health care coverage and local service. Asuris Northwest Health is a subsidiary of Regence Blue Shield.
Blue Cross & Blue Shield Association (BCBSA) - A nonprofit corporation located in Chicago, Illinois, formed by Blue Cross and Blue Shield Plans to act as the national coordinating agency for independent licensees of the BCBSA.
COBRA (Consolidated Omnibus Budget Reconciliation Act of 1985) - Federal law affecting continuation of employer-based health benefit coverage beyond the point when termination of health benefits would normally occur.
Coinsurance - An arrangement under which the member shares a stated portion (usually a percentage) of the cost of care. For instance, under a plan in which there is an 80% coinsurance, the carrier would pay 80% of the allowed amount for the cost of the care. The member would pay the remainder of the cost until their out-of-pocket maximum has been met.
Common Eligibility - A Trust Policy that states a company must have matching enrollment of all enrolled employees/dependents on all lines of coverage offered through the MBA Trust.
Coordination of Benefits (COB) - A provision designed to avoid duplicate payments or payments in excess of charges for benefits covered under more than one individual or group contract.
Copayment or Copay - A specified out-of-pocket dollar amount that a member must pay for a specified service at the time the service is rendered.
Deductible - A member’s stated portion of the cost of care before certain contractual benefits are paid. For example, if a plan has a $300 deductible, the deductible is met once the member has paid the first $300 of the covered medical expenses for that year. After that, the plan begins to pay a percentage toward the cost of covered healthcare services.
Employee Assistance Program (EAP) – an employer-sponsored service designed to promote wellness and assist employees and their families in preventing or resolving problems affecting productivity and morale. The EAP also includes limited legal consultation services.
Employee / Subscriber - The person whose application for coverage under a particular contract has been accepted by the MBA Health Insurance Trust and on whose behalf the rate for coverage is paid.
Explanation of Benefits (EOB) - Notification that is sent to members for each claim incurred. The EOB explains how the services were covered.
Exclusions - Provisions in the contract stating situations, services or conditions for which benefits are not provided.
Group Health Options - A Point-of-Service program offered through Group Health Cooperative. Beginning in 1947, it became the nation’s largest consumer-governed, nonprofit health care system.
Health Care Service Contractor - A company similar to an insurance company, but formed under special laws and registered as such by the State Insurance Commissioner, which has participating providers who supply medical services. Regence Blue Shield and Asuris Northwest Health are health care service contractors.
HSA Plan - Health Savings Accounts are a new form of consumer driven health plans designed to assist employers in controlling health care costs. These plans allow employees to pay for certain health expenses with funds from their Health Savings Account.
Magellan Behavioral Health - The nation’s leading employee assistance company covering more than 55 million employees and their dependents nationwide.
Member - A person covered by a MBA Trust plan. This can mean an employee/subscriber or dependent.
PCP (Personal Care Provider or Primary Care Provider) - The network physician chosen by a member on a point-of-service plan to coordinate all health-related services.
Point-of-Service Plan - These are managed care plans with a variety of copay and deductible options. Members must choose a Personal Care Provider from the provider network. For the highest level of benefits, care needs to be coordinated or provided by the Personal Care Provider. Lesser coverage may be provided if the member self-refers or uses a provider outside the provider network. Members may self-refer for some care and should consult their benefit booklet for specific details.
Portability of Coverage - Washington State law requires health plans to credit waiting periods for pre-existing conditions if the individual was continuously covered by a comparable health plan immediately prior to the effective date under the new health plan.
Pre-existing Condition - In group health insurance, this is a condition for which an individual received medical care during the three months immediately prior to the effective date of coverage.
Preferred Plans (PPO) - Preferred plans usually cover a percentage of the cost of services once a deductible is met. Members may see any contracted Preferred (PPO) provider. Preferred Plans have a variety of coverage choices such as deductible, copay and coinsurance.
Regence Blue Shield - A health care service contractor in Washington State. Regence Blue Shield’s corporate headquarters is located in Seattle, Washington, and is a charter member of The Regence Group. See the Regence website for a listing of local offices throughout the state.
Regence Life & Health Insurance Company - A regional life and disability carrier that underwrites term life and accidental death & dismemberment benefits for the MBA Health Insurance Trust.
Service Area - The geographical area covered by a network of healthcare providers.
Traditional Plans - Traditional plans usually provide a percentage of the cost of covered services once a deductible is met. Members may see any contracted participating (PAR) provider. Non-contracted providers are not covered.
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